U.S. Attorney Richard Roper announced that Joel A. Holiner, M.D. and Texas-based Holiner Psychiatric Group P.A. (HPG) agreed to pay $250,000 and enter into a five-year integrity agreement with the government to settle allegations that they violated the civil False Claims Act (FCA) by “upcoding” health care claims that were submitted to the government.
“Upcoding” is the practice of submitting claims to a health care program for a more expensive service than was actually performed. The FCA prohibits any person from knowingly presenting false or fraudulent claims, or making false statements in support of those claims, to the government for payment. The FCA further permits the government to seek up to three times the amount of damages suffered by the government and up to $11,000 per false claim made.
Under the terms of the integrity agreement, Dr. Holiner and HPG are required to implement certain compliance measures including the training of staff and group physicians and audits of health care claims submitted to the government
Dr. Holiner is the managing shareholder of HPG, a Dallas area practice group consisting of physicians specializing in providing outpatient and inpatient psychiatric medicine to both private and federal beneficiaries.
The United States alleged that between Jan. 1, 1998, through Dec. 31, 2003, Dr. Holiner, through HPG, upcoded claims for physician services (that were later paid by the government) that he furnished to Medicare, Medicaid, and Tricare program beneficiaries while they were patients at several area hospitals. The United States alleged that Dr. Holiner falsely represented to the government the time he spent treating patients along with the complexity of those patients’ psychiatric conditions.
As a result, the government paid Dr. Holiner and HPG more money than they were entitled to receive.